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BFA| Quality Assurance Survey
Bright Futures Ahead
5411 Old Frederick Road, Suite 4, Baltimore, MD 21229
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Email
*
Your email
General Information
Client Name:
*
Your answer
Primary Phone Number:
*
Your answer
Services Provided/Assigned Staff:
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Therapy
Medication Management
PRP Services
Substance Abuse Services
Required
Therapist:
Your answer
Behavior Counselor/PRP:
Your answer
Psychiatrist:
Your answer
Substance Abuse Counselor:
Your answer
Quality Assessment
How well are you adjusting with BFA services?
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Unacceptable
1
2
3
4
5
Superior
Overall, how well do you relate to your assigned counselor/therapist?
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Unacceptable
1
2
3
4
5
Superior
How adequate is the amount of time provided per visit/session?
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Unacceptable
1
2
3
4
5
Superior
How are you benefiting from the Therapy/Med Management/PRP services?
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Unacceptable
1
2
3
4
5
Superior
How satisfied are you with the frequency/length of visits/sessions?
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Unacceptable
1
2
3
4
5
Superior
How satisfied are you with the communication between you and the counselor/therapist?
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Unacceptable
1
2
3
4
5
Superior
How would you rate your level of satisfaction with the services being provided?
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Unacceptable
1
2
3
4
5
Superior
How satisfied are you with medication management services?
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Unacceptable
1
2
3
4
5
Superior
How satisfied are you with the transportation services provided?
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Unacceptable
1
2
3
4
5
Superior
If you are unsatisfied with any of your services provided, please detail here: (provide as much information as possible including which service is problematic and/or which staff member isis problematic)
*
Your answer
Thank you for participating, are there any suggestions regarding Parker Psychiatric Services that you would like to offer in order for us to improve service delivery?
Your answer
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